Echocardiographic evaluation of diastolic heart failure

The term “diastology” characterises left ventricular (LV) relaxation, filling dynamics and their integration into clinical practice. Recent advances in echocardiography have enabled the understanding of this complex process, particularly relevant in the setting of an aging population and rising prevalence of heart failure (HF) with preserved systolic function. Data from the Mayo Clinic and others indicate that diastolic heart failure (DHF) accounts for approximately 50% of all HF cases and carries a poor prognosis with survival being similar to those with a reduced ejection fraction, (5-year mortality ~ 50% in new onset symptomatic DHF). Additionally, the prevalence of asymptomatic diastolic dysfunction (DD) in the general community is ~ 25–30% in individuals ≥ 45 years. Diastolic dysfunction (DD) is defined as “inability of the LV to fill during rest or exercise, to a normal end-diastolic volume without an abnormal increase in LV end diastolic pressure (LVEDP)”. Diastolic function is frequently abnormal in patients with reduced LVEF and HF. Hence, the recent criteria of The European Society of Cardiology recommends the diagnosis of DHF or HF with normal Ejection Fraction (HFNEF) be based on the following: (i) signs or symptoms of HF; (ii) normal or mildly abnormal LV systolic function without LV dilatation (LVEF > 50%, LV end-diastolic volume index (LVEDVI) < 97 mL/m.) and (iii) evidence of LV DD.